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Chapter Seventeen - Conclusion

Rhona M. Fear Karnac Books ePub

I was motivated to write this book because I wanted to share with those who have the same love of the profession the specific way that I find it is best to interact with the client. We all want the client, by the time he leaves therapy, to have lost his dysfunctional patterns of relating, and to no longer be in the grip of his major pathology or pathologies. When we are noviate therapists, we talk about “cure” for the client; as we become mature therapists, we realise that, perhaps, in the vast majority of cases, the best that we can hope for is that our work together will lead to a diminution of his pathologies, so that his life is no longer ruled by them. However, it is very likely that some residue of his pathological way of living will remain in evidence, especially at times of stress or ill-health.

I have given hundreds of hours during my twenty-seven years in practice to the thorny question of how I should function as a therapist in the consulting room in order to achieve the best outcome for the majority of my clients. In contemplating this subject, I have studied various theories. As stated earlier, my introduction into the counselling world was eclectic: at Relate, we used a toolbox of different techniques, selecting our style of intervention depending upon how we viewed its likely efficacy given the presenting problem. However, despite the fact that the training was eclectic, with very little emphasis upon the elucidation of different theories, I intuitively recognised, even at this innocent stage of training, that the psychodynamic perspective seemed most efficacious.

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15. It’s a Mystery to Me

Peter Block Berrett-Koehler Publishers ePub

it’s a mystery to me.         Part of what drives the instrumental culture and keeps us entangled in practicality is our need for certainty. This is inevitably frustrated by the nature of human systems. Much of what we know about how people change or how organizations develop is based on anecdote and intuition. The social sciences are highly social with very little science. Much of the research in psychology has been done with college students, since they are the only subjects that are available and affordable. Research in living systems uses the term research in the broadest terms, since it is impossible to create controlled conditions in a human operating system. One of the tenets of science is that the research be replicable, which is impossible in a social system.

Trying to contain human endeavors within the realm of certainty or science or engineering is both futile and harmful. Try as we might, we are unable to remove the mystery from life. We are constantly confronted with the difficulty of acting on our idealism and pursuing an unreachable depth, and are left with little more than paradox: the idea that for every great idea, there is an opposite idea that is also true.

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5. The communicative-adaptational model of the mind

Robert Langs Karnac Books ePub

To this point, we have generated a variety of formulations of the material from our clinical vignette. Each line of thought stressed the intrapsychic operations of the human mind as observed within a globally conceptualized therapeutic interaction. We found that these formulations suggested a rather broad view of the design of the mind as being three interconnected systems—originally, UCS, PCS, and CS; later on, id, ego, and superego.

Something unexpected and almost magical occurs when we shift our way of observing and formulating into a mode that centres on immediate adaptive responsiveness in lieu of the vague and general (weak) adaptational approach characteristic of the standard viewpoints on psychotherapy. A major transformation takes place in our thinking and in our model of the mind. Let us see how this dramatic change comes about.


The description of the transactions of Ms Allen’s therapy— the clinical material or observables I presented earlier—and the previously discussed formulations of her free-associations would satisfy most present-day therapists. There would be some debate over the most important implications of the patient’s material, but the clinical data would not be found wanting.

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CHAPTER FOUR: Psychological issues in spiritual direction

Lynette Harborne Karnac Books ePub

“What is madness but nobility of the soul at odds with circumstance …”

—Theodore Roethke 1908-1963

Having explored the subject of the inclusion of spiritual questions in therapy in the previous chapter, we now come to the question of how to recognise and engage with psychological issues in spiritual direction. This chapter will look at the nature of the spiritual direction encounter, the desirability of initial history taking, and whether and how a risk assessment may be formulated. The whole area of working with clergy will be explored, together with the importance of a sound understanding of unconscious process. Questions about the difficulties and ambiguities that present themselves when we try to differentiate between psychosis and mysticism will be raised, and ethical and possible legal consequences identified. When and how to refer will form the final part of the chapter.

Having urged therapists to be willing to explore spiritual issues with their clients, I find myself wondering whether I hold the same attitude to spiritual directors whose directees present with psychological issues, and, if not, why not. In reality, I do see some differences in the two situations as they exist at the moment. Firstly, far fewer people enter spiritual direction in a state of crisis, or even acute personal difficulty, than is the case for therapy clients, so the inherent dangers are considerably less. There is also the question of the interval between sessions. Psychotherapy is likely to be on a weekly basis while spiritual direction may well only take place every few weeks or even months, which is a significant difference. However, it is worth noting that a particular model of spiritual direction, which follows the “Spiritual Exercises” of St Ignatius, is offered either on a daily basis for thirty days or on a weekly basis over a period of months, thus reflecting the therapeutic tradition.

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Bion, Wilfred R. Karnac Books PDF



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‘Memory and Desire’ was given without notes and without a pre-circulated version of the paper at a Scientific Meeting at the British Psychoanalytical Society on Wednesday

16 June 1965, but it was never published. In 2014, a recording of the 1965 presentation was found, which I transcribed. I am indebted to the Archivist of the British

Psychoanalytical Society, Joanne Halford, for making the recording available to me to transcribe. The paper was published in the May 2014 issue of the Bulletin of the British

Psychoanalytical Society (for Members, Candidates and Guests of the Society only).

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Even the simple act which we describe as ‘seeing someone we know’ is, to some extent, an intellectual process. We pack the physical outline of the creature we see with all the ideas we already formed about him, and in the complete picture of him which we compose in our minds those ideas have certainly the principal place.

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